Pathological staging of muscle invasive bladder cancer. Is substaging of pT2 tumors really necessary?

Objective: Compare clinical outcomes in patients having urothelial tumors invading less than one half of the depth of bladder muscle and greater than one half of bladder muscle and, to determine various clinical variables as predictive factors for survival.
Materials and Methods: According to our inclusion criteria, 57 patients among cases with T2 bladder tumor were selected. Thirty-five patients (61.4 %) had pT2a (Group-1) and 22 patients (38.6%) had pT2b (Group-2) muscle invasive tumors. Mean follow up time was 7.3 years for Group-1, and 6.1 years for Group-2. Multivariate analysis was performed in order to identify possible correlation of clinical variables like age, gender, grade of primary tumor, appearance of local and/ or distant metastasis with patient outcome.
Results: Five year recurrence-free and overall survival rates were 69.1% and 44.3% for patients with pT2a tumor, whereas these ratios were 66.1% and 43%, respectively for patients with pT2b tumor (p = 0.896; p = 0.975). Mean overall and progression-free survival times were 87.7 +/- 13.8 and 116 +/- 13.12 months for Group-1, while they were 73.8 +/- 13.7 and 88.85 +/- 12.55 months for Group-2, respectively. On both univariate and multivariate analysis, age was noticed as an independent predictive factor for survival.
Conclusions: The depth of muscle invasion in bladder tumors has no prognostic significance. Recurrence of the disease either locally or at distant sites dramatically shortens patients' life. Being older than 60 years old during the time of radical surgery, is also a bad prognostic factor for overall and progression-free survival.